• Clinical Endoscopy
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• v.57 no.2
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• pp.164-174
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• 2024

Pancreatic cancers have a poor prognosis, and their incident rates have risen. Endoscopic ultrasonography (EUS) is an efficient and reliable diagnostic modality for pancreatic lesions, providing high spatial resolution. However, while EUS helps to detect minor pancreatic lesions, nearly all solid pancreatic lesions are hypoechoic, which creates difficulty in making differential diagnoses of pancreatic lesions. When diagnosing pancreatic lesions, the performance of image-enhanced EUS techniques is essential, such as EUS elastography or contrast-enhanced harmonic EUS (CH-EUS). CH-EUS diagnosis is based on assessing the vascularity of lesions, whereas tissue elasticity is measured via EUS elastography. Elastography is either strain or shear-wave, depending on the different mechanical properties being evaluated. The usefulness of enhanced EUS techniques is demonstrated in this review for the differential diagnosis of pancreatic lesions, including solid and cystic lesions, and pancreatic cancer staging.

• Clinical Endoscopy
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• v.56 no.1
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• pp.100-106
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• 2023

Background/Aims: Endoscopic ultrasound (EUS) has become an essential diagnostic and therapeutic tool. EUS was introduced in 2013 in Indonesia and is considered relatively new. This study aimed to describe the current role of interventional EUS at our hospital as a part of the Indonesian tertiary health center experience. Methods: This retrospective study included all patients who underwent interventional EUS (n=94) at our center between January 2015 and December 2020. Patient characteristics, technical success, clinical success, and adverse events associated with each type of interventional EUS procedure were evaluated. Results: Altogether, 94 interventional EUS procedures were performed at our center between 2015 and 2020 including 75 cases of EUS-guided biliary drainage (EUS-BD), 14 cases of EUS-guided pancreatic fluid drainage, and 5 cases of EUS-guided celiac plexus neurolysis. The technical and clinical success rates of EUS-BD were 98.6% and 52%, respectively. The technical success rate was 100% for both EUS-guided pancreatic fluid drainage and EUS-guided celiac plexus neurolysis. The adverse event rates were 10.6% and 7.1% for EUS-BD and EUS-guided pancreatic fluid drainage, respectively. Conclusions: EUS is an effective and safe tool for the treatment of gastrointestinal and biliary diseases. It has a low rate of adverse events, even in developing countries.

• Clinical Endoscopy
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• v.57 no.2
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• pp.175-180
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• 2024

Therapeutic endoscopic ultrasonography (EUS) procedures using the forward-viewing convex EUS (FV-EUS) have been reviewed based on the articles reported to date. The earliest reported procedure is the drainage of pancreatic pseudocysts using FV-EUS. However, the study on drainage of pancreatic pseudocysts focused on showing that drainage is possible with FV-EUS rather than leveraging its features. Subsequently, studies describing the characteristics of FV-EUS have been reported. By using FV-EUS in EUS-guided choledochoduodenostomy, double punctures in the gastrointestinal tract can be avoided. In postoperative modified anatomical cases, using the endoscopic function of FV-EUS, procedures such as bile duct drainage from anastomosis, pancreatic duct drainage from the afferent limb, and abscess drainage from the digestive tract have been reported. When a perpendicular puncture to the gastrointestinal tract is required or when there is a need to insert the endoscope deep into the gastrointestinal tract, FV-EUS is considered among the options.

• Clinical Endoscopy
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• v.57 no.2
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• pp.246-252
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• 2024

Background/Aims: Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (EUS-HGS) is useful for patients with biliary cannulation failure or inaccessible papillae. However, it can lead to serious complications such as bile peritonitis in patients with ascites; therefore, development of a safe method to perform EUS-HGS is important. Herein, we evaluated the safety of EUS-HGS with continuous ascitic fluid drainage in patients with ascites. Methods: Patients with moderate or severe ascites who underwent continuous ascites drainage, which was initiated before EUS-HGS and terminated after the procedure at our institution between April 2015 and December 2022, were included in the study. We evaluated the technical and clinical success rates, EUS-HGS-related complications, and feasibility of re-intervention. Results: Ten patients underwent continuous ascites drainage, which was initiated before EUS-HGS and terminated after completion of the procedure. Median duration of ascites drainage before and after EUS-HGS was 2 and 4 days, respectively. Technical success with EUS-HGS was achieved in all 10 patients (100%). Clinical success with EUS-HGS was achieved in 9 of the 10 patients (90%). No endoscopic complications such as bile peritonitis were observed. Conclusions: In patients with ascites, continuous ascites drainage, which is initiated before EUS-HGS and terminated after completion of the procedure, may prevent complications and allow safe performance of EUS-HGS.

• Clinical Endoscopy
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• v.57 no.4
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• pp.527-533
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• 2024

Background/Aims: Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (EUS-HGS) performed at the intrahepatic bile duct segment 3 (B3) is widely used for biliary drainage. Although performing post-puncture procedures is easier in the intrahepatic bile duct segment 2 (B2) when using a conventional oblique-viewing (OV) EUS scope, this method may cause transesophageal puncture and severe adverse events. We evaluated the safety and efficacy of B2 puncture using a novel OV-EUS scope. Methods: In this single-center retrospective study, we prospectively enrolled and collected data from 45 patients who consecutively underwent EUS-HGS procedures with a novel OV-EUS scope between September 2021 and December 2022 at our cancer center. Results: The technical success rates of B2-EUS-HGS and EUS-HGS were 93.3% (42/45) and 97.8% (44/45), respectively. The early adverse event rate was 8.9% (4/45) with no cases of scope changes or transesophageal punctures. The median procedure time was 13 minutes (range, 5-30). Conclusions: B2-EUS-HGS can be performed safely with the novel EG-740UT (Fujifilm) OV-scope without transesophageal puncture and with a high success rate. B2-EUS-HGS using this novel OV scope may be the preferred strategy for EUS-HGS.

• Clinical Endoscopy
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• v.57 no.5
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• pp.588-594
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• 2024

Endoscopic ultrasound (EUS)-guided interventions have evolved rapidly in recent years, with dedicated metal stents playing a crucial role in this process. Specifically, the invention of biflanged short metal-covered stents, including lumen-apposing metal stents (LAMS), and modifications in a variety of tubular self-expandable metal stents (SEMS), have led to innovations in EUS-guided interventions. LAMS or non-LAMS stents are commonly used in the EUS-guided drainage of pancreatic fluid collections, especially in cases of walled-off necrosis. Additionally, LAMS is commonly considered for drainage of the EUS-guided gallbladder or dilated common bile duct and EUS-guided gastroenterostomy. Fully or partially covered tubular SEMS with several new designs are being considered for EUS-guided biliary drainage. This review focuses on advances in SEMS for EUS-guided interventions and discusses related research results.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.24 no.2
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• pp.164-172
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• 2021

Purpose: The use of Endoscopic ultrasonography (EUS) in pediatric patients is not as common as in adults. The aim of this study is to evaluate the role of EUS in the diagnosis of pancreatobiliary disease in childhood. Methods: Between December 2016 and January 2018, the findings of patients who underwent EUS were evaluated retrospectively. Results: Of the 41 patients included in the study 25 were girls (61.0%), mean age was 12.2±4.2 years. EUS was performed for biliary colic in 21 (51.2%), for recurrent pancreatitis in 12 (29.2%), for cholecystitis/cholangitis in 5 (12.2%), and for acute pancreatitis in 3 (7.4%) patients. EUS had a significant clinical effect in the decision of treatment and follow-up of 6/21 biliary colic cases, in diagnosis and follow-up of 6/12 recurrent pancreatitis cases, in decision-making and monitoring of invasive procedures (ERCP/surgery) of 3/5 acute cholecystitis/cholangitis and 2/3 of acute pancreatitis cases as well as in follow-up of the other cases. The effectiveness of EUS in determining direct treatment and invasive intervention was 43.9%. None of the patients had complications related to the EUS procedure. Conclusion: Although current guidelines show that EUS can be used in pediatric patients, this is limited to a few published studies. In this study, it is shown that EUS is a safe method for the diagnosis, follow-up and treatment of common pancreatobiliary pathologies in childhood.

• Clinical Endoscopy
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• v.55 no.2
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• pp.279-286
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• 2022

Background/Aims: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a standard procedure for obtaining tissue from lesions near the gastrointestinal lumen. However, there is a scarcity of information on the diagnostic performance of EUS-FNA for abdominal lymphadenopathy of unknown causes. To assess the accuracy of EUS-FNA in diagnosing abdominal lymphadenopathy of unknown etiology. Methods: The EUS records of patients with undiagnosed abdominal lymphadenopathy between 2010 and 2015 were reviewed. Results: A total of 42 patients were included in this study. Adequate specimens were obtained from 40 patients (95%). The final diagnoses were metastatic cancer (n=16), lymphoma (n=9), tuberculosis (n=8), inflammatory changes (n=6), and amyloidosis (n=1). For diagnosing malignancy, EUS-FNA had a sensitivity of 84.6%, specificity of 95.7%, positive predictive value of 91.7%, negative predictive value of 91.7%, and area under the receiver operating characteristic curve (AUROC) of 0.901. For the diagnosis of lymphoma, EUS-FNA was 100% accurate when combined with cytologic evaluation and immunohistochemical staining. The diagnostic sensitivity decreased to 75%, whereas the specificity remained 100%, for tuberculosis. The overall AUROC was 0.850. No procedure-related complications occurred. Conclusions: EUS-FNA showed high diagnostic performance for abdominal lymphadenopathy of unknown causes, especially malignancy, lymphoma, and tuberculosis. Therefore, it is a crucial diagnostic tool for this patient population.

• The Journal of the Korean life insurance medical association
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• v.24
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• pp.79-96
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• 2005

1. 연구배경과 문제제기 - 보험시장의 환경변화 : 보험업법 개정, 방카슈랑스 도입, 고(高)보장성 생존급부(CI, LTC)상품의 등장, 통신판매 전문보험회사의 설립 허용 - 현행 언더라이팅 시스템의 문제점 : 위험난이도와 판매 채널별 특성이 고려되지 않고 언더라이터에 전건 배정 되어 업무의 효율성이 낮음 - 보험시장의 환경변화에 맞는 EUS(Expert Underwriting System) 도입으로 언더라이팅의 효율성을 증대하고자함 2. 국내/외 생보사 언더라이팅 시스템 현황 비교 및 개선방안 - 국내 언더라이팅 시스템 현황 : 청약서 입력/스캔 후 진단 및 적부 유무(有無)에 따라 자동으로 언더라이터에게 심사가 배정됨 - 미국 언더라이팅 시스템 현황 : EUS에 의한 1차 전산승낙여부 결정 후(後)언더라이터에게 심사가 배정됨 - 위험난이도의 고저(高低)와 관계없이 언더라이터에 배정되는 심사시스템의 문제점을 극복하고 체계적인 위험평가를 위해 EUS도입이 필요함 3. EUS 선행요건 - 고객정보의 확보 - 국내 생보사의 고객정보 수집원 : 청약서, 모집인 보고서, 건강진단서,적부조사, 보험사고정보조회시스템 (ICPS), 고액보험 및 상해보험 중복가입자에 대한 정보 교환제도 - 북미 생보사의 고객정보 수집원 : 청약서, 모집인 보고서, 의사소견서 및 진료기록서, 건강검진, 적부조사, 정보교환제도( 북미보험사간 의료정보 공유-MIB) - 정확한 고객정보의 확보방안 : 법률/제도의 정비, 청약서 질문 내용의 세분화, 의료정보교환제도의 구축 4. EUS 개요 및 현황 - EUS의 정의: 고객의 정보를 입력하여 청약부터 보험증권 발행 단계까지 One-Stop 서비스를 제공하는 것으로 언더라이터가 청약서를 가지고 언더라이팅 하는 것과 동일한 업무를 할 수 있는 전문가 시스템 - EUS의 장점: (1) 비용절감 및 인력의 효율적 활용 (2) 업무별 시스템화 되는 조직속성에 적합함. (3) 언더라이팅 정책이 경영 환경 변화에 대처하는데 신속함 - 국외 EUS 현황 (예: Cologne Re) 및 사례연구 5. 위험분류 및 EUS 개요현황 (언더라이팅 시스템 도입) - 위험관리 선행요건으로 위험요소별 분류가 체계적으로 수립되어야 함. - 데이터웨어하우스 (의사결정을 목적으로 설계된 조회와 분석이 가능한 통합된 정보저장소) 시스템 사용 - EUS 도입을 통한 언더라이팅 프로세스: 데이터마이닝 과정을 통해 "자동승낙, 언더라이터에게 심사배정, 적부의뢰, 진단의뢰, 텔레 언더라이터, 보완지시"등이 결정됨. 6. 판매채널별 EUS 활용방안 - 대면채널: 효용성 높은 정보제공과 정확한 위험분석이 가능한 시스템으로 고(高)보장, 고(高)위험 상품에 대해 언더라이터가 집중 심사 할 수 있게 함. - 방카슈랑스: 3S(간결, 신속, 서비스)의 특성에 맞는 전과정 무인자동심사시스템 - 비대면채널: 판매상품과 타겟시장을 명확히 한 후 도덕적 위험과 재무적 위험에 대한 평가시스템 및 의사결정 시스템을 도입 7. 결론 - EUS 도입의 기대효과 (1) 심사기일의 단축으로 고객만족 실현 (2) 체계적 과학적 리스크 관리로 위험률차익 증대에 기여 (3) 업무효율의 증대와 언더라이터의 역량강화 (4) CRM 활용증대와 모바일 청약시스템 구축의 근간 - EUS 도입시 경제적 법률적 제도적 문제 극복과 생보 업계 공동의 관심과 노력이 필요함 - EUS를 활용하여 종합적.체계적 리스크 관리가 가능한 금융회사로의 경쟁력 향상에 기여함.

• Clinical Endoscopy
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• v.56 no.1
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• pp.107-113
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• 2023

Background/Aims: Immune checkpoint blockade has recently been reported to be effective in treating microsatellite instability (MSI)-high tumors. Therefore, sufficient sampling of histological specimens is necessary in cases of unresectable pancreatic cancer (UR-PC). This multicenter study investigated the efficacy of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) using a Franseen needle for MSI evaluation in patients with UR-PC. Methods: A total of 89 patients with UR-PC who underwent endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) or EUS-FNB using 22-G needles at three hospitals in Japan (2018-2021) were enrolled. Fifty-six of these patients (FNB 23 and FNA 33) were followed up or evaluated for MSI. Patient characteristics, UR-PC data, and procedural outcomes were compared between patients who underwent EUS-FNB and those who underwent EUS-FNA. Results: No significant difference in terms of sufficient tissue acquisition for histology was observed between patients who underwent EUS-FNB and those who underwent EUS-FNA. MSI evaluation was possible significantly more with tissue samples obtained using EUS-FNB than with tissue samples obtained using EUS-FNA (82.6% [19/23] vs. 45.5% [15/33], respectively; p<0.01). In the multivariate analysis, EUS-FNB was the only significant factor influencing the possibility of MSI evaluation. Conclusions: EUS-FNB using a Franseen needle is desirable for ensuring sufficient tissue acquisition for MSI evaluation.